Implementation strategies of a contract-based MRI examination reservation process for stroke patients

International audienceTimely imaging examinations are critical for stroke patients due to the potential life threat. We have proposed a contract-based Magnetic Resonance Imaging (MRI) reservation process [1] in order to reduce their waiting time for MRI examinations. Contracted time slots (CTS) are especially reserved for Neural Vascular Department (NVD) treating stroke patients. Patients either wait in a CTS queue for such time slots or are directed to Regular Time Slot (RTS) reservation. This strategy creates "unlucky" patients having to wait for lengthy RTS reservation. This paper proposes and analyzes other contract implementation strategies called RTS reservation strategies. These strategies reserve RTS for NVD but do not direct patients to regular reservations. Patients all wait in the same queue and are served by either CTS or RTS on a FIFO (First In First Out) basis. We prove that RTS reservation strategies are able to reduce the unused time slots and patient waiting time. Extensive numerical results are presented to show the benefits of RTS reservation and to compare various RTS reservation strategies

Cerebrovascular Anatomy, Neuropathology, Clinics of Stroke: Endovascular Treatment, Decompressive Craniectomy

Stroke, a disease of millions, and a financial burden for many more is still challenging health sciences, as we greatly increase our efforts to better understand stroke pathogenesis, early diagnose, prevent and treat high risk and major risk factors we still need to update our clinical and surgical skills in treating stroke event and its aftermath. Use of applied anatomical and physiological knowledge should apply the same everywhere, and based on these standard principles we should be able to predict the early course of stroke neuropathology and its potential consequences. Updated new guidelines of recombinant tissue plasminogen activator (r-tPA) indications should help in early intervention when correct diagnosis is promptly made, but as the list of contraindications as well has changed staff neuroscientists should consider all possible medical and or surgical options for treatment. With prompt actions to try to reinstate perfusion we should always try to do so within the first 4 h, and having a maximal additional 2 h in reserve to consider surgical therapeutic options (should the clinic/unit’s infrastructure allow it). Treatment modalities, therapeutic/endovascular and or surgical (embolectomy, bypass, decompression) are the alternatives among which we should wisely chose to treat our patients based on the best medical practice not in the skills of the individuals performing each or either procedure. It is of critical importance to know when surgery should be performed, how to calculate craniotomy size, what are the intra-, extra-cranial surgical landmarks and when should we put the bone back in cases of decompression. We should be able to correctly predict at what extent volume and intracranial pressure values will change by the size of decompressive craniectomy and its effect on the patient’s prognosis. Clinic is the best indicator for timing of surgical decompression as it is the sole determinant of any other treatment option, and what high risk and major risk factors are present (if any) at the time of diagnosis will predict the clinical outcome of the patient, but not the age (which should not be the limit)

Machine learning approaches for early prediction of hypertension.

Hypertension afflicts one in every three adults and is a leading cause of mortality in 516, 955 patients in USA. The chronic elevation of cerebral perfusion pressure (CPP) changes the cerebrovasculature of the brain and disrupts its vasoregulation mechanisms. Reported correlations between changes in smaller cerebrovascular vessels and hypertension may be used to diagnose hypertension in its early stages, 10-15 years before the appearance of symptoms such as cognitive impairment and memory loss. Specifically, recent studies hypothesized that changes in the cerebrovasculature and CPP precede the systemic elevation of blood pressure. Currently, sphygmomanometers are used to measure repeated brachial artery pressure to diagnose hypertension after its onset. However, this method cannot detect cerebrovascular alterations that lead to adverse events which may occur prior to the onset of hypertension. The early detection and quantification of these cerebral vascular structural changes could help in predicting patients who are at a high risk of developing hypertension as well as other cerebral adverse events. This may enable early medical intervention prior to the onset of hypertension, potentially mitigating vascular-initiated end-organ damage. The goal of this dissertation is to develop a novel efficient noninvasive computer-aided diagnosis (CAD) system for the early prediction of hypertension. The developed CAD system analyzes magnetic resonance angiography (MRA) data of human brains gathered over years to detect and track cerebral vascular alterations correlated with hypertension development. This CAD system can make decisions based on available data to help physicians on predicting potential hypertensive patients before the onset of the disease

Peritumoral tissue compression is predictive of exudate flux in a rat model of cerebral tumor: an MRI study in an embedded tumor

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/115972/1/nbm3418.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/115972/2/nbm3418_am.pd

Labeling of immune cells for in vivo monitoring of cell migration using magnetic resonance imaging and near-infrared imaging

In addition to macrophage localization, the opening of the blood brain barrier (BBB) as well as demyelination processes have been measured by MRI mapping gadolinium (Gd) related signal enhancement and magnetic transfer (MT), respectively. By successively applying this protocol at different time points during the EAE model progression, we were able to analyse the interdependence of immuno-cellular processes leading to axonal damage as well as the longitudinal evolution of pathological hallmarks of EAE. Furthermore, these techniques have been used to validate and quantify the anti-inflammatory effect of EDG-1 inhibitor FTY720 on EAE symptoms. Repeated USPIO administrations and MRI measurements combining the analysis of MT ratios and Gd-enhancement have been performed on vehicle and FTY720 treated animals. This study demonstrates that FTY720 can prevent inflammatory events in EAE rats by sequestrating immune cells in lymphoid organs during acute inflammation episodes. The third goal, was to translate the iron-labeling protocol from macrophages to T lymphocytes. As T-cells are initiators of the immune cascade leading to the occurence of symptoms in the EAE model, it would be highly relevant to visualize T lymphocytes prior to the onset of symptoms. Yet, as lymphocytes have no natural phagocytotic activity, in vivo tagging with CA was not feasible. We decided to label them in vitro with ferumoxides (FeO) and then, transfer iron-presenting cells adoptively to EAE animals intravenously. Different techniques have been used to evaluate the efficiency of lymphocytes labeling combining iron oxide particles with commonly available transfection agents (TAs) and the feasibility of labeling T lymphocytes in vitro has been demonstrated. However, the adoptive transfer of iron-tagged T-cells to EAE rats did not lead to the detection of these cells by MRI. As MR detection of iron-tagged cell in vivo was unsuccessful probably due to the inherent lack of sensitivity of the MRI technique for molecular changes and the dilution of labeled cells in the blood, we decided to switch to a more sensitive technique. Thus, the goal of the last part of the thesis was to label primary cultured T lymphocytes with a fluorescent dye: cyanine 5.5 (Cy5.5). The Tat peptide from the HIV virus chemically has been bound to the Cy5.5 to cargo the dye across T-cells membrane. The ability of this probe to penetrate T-cells and its potential toxicity has been evaluated in vitro. Subsequently, Cy5.5-Tat labeled lymphocytes were transferred to EAE rats in order to monitor their bio-distribution during EAE. Prominent signals have been obtained from rat brain and histological experimentation using confocal microscopy analysis have been performed to confirm the localization of Cy5.5 within the brain parenchyma

Semantic radical consistency and character transparency effects in Chinese: an ERP study

BACKGROUND: This event-related potential (ERP) study aims to investigate the representation and temporal dynamics of Chinese orthography-to-semantics mappings by simultaneously manipulating character transparency and semantic radical consistency. Character components, referred to as radicals, make up the building blocks used dur...postprin

Markov chain Monte Carlo analyses of longitudinal biomedical magnetic resonance data

Markov chain Monte Carlo simulation was used in an analysis of the data acquired in three longitudinal biomedical magnetic resonance studies. The first of these investigations uses a Bayesian nonlinear hierarchical random coefficients model to examine the longitudinal extracellular direct current (DC) potential and apparent diffusion coefficient (ADC) responses to focal ischaemia in the rat. The purpose is to perform a formal analysis of the temporal relationship between the two responses, and thus to examine the data for compatibility with a common latent (driving) process and, alternatively, the existence of an ADC threshold for anoxic depolarisation. The DC-potential and ADC transition parameter posterior probability distributions were generated, paying particular attention to the within-subject differences between the DC-potential and ADC transition characteristics. The results indicate that the DC-potential and ADC changes are not driven by a common latent process and, in addition, provide no evidence for a consistent ADC threshold associated with anoxic depolarisation. The second analysis uses data acquired in a nuclear magnetic resonance spectroscopic study into the effects of intestinal ischaemia and subsequent reperfusion on liver metabolism in the rat. The purpose of the analysis is to examine the temporal relationship between energy status [inorganic phosphate to adenosine triphosphate ratio (PAR)] and the pH response, the former of which is an indicator of liver energy failure. The posterior distribution obtained for the PAR-pH onset time difference indicates that the pH response precedes the change in PAR, suggesting that intracellular acidosis cannot be ruled out as a contributing factor to the observed liver failure. The third dataset was acquired in an electron spin resonance study of the Arrhenius behaviour of the rabbit muscle sarcoplasmic reticulum membrane. An MCMC Arrhenius plot changepoint analysis is used to estimate the order parameter 'transition' temperature